Exercise Training Benefits Marker of Cardiovascular Risk

The World Heart
Federation has published a report that the leading cause of increasing
prevalence of cardiovascular disease among Indians is due to:

Physical inactivity - 79% men and 83% women

High fat diet - 51% men and 48% women

High Blood Pressure - 33% men and 30% women

Diabetes - 34% men and 37% women

The alarmingly high percentage of
physically inactive people and the increasing numbers of cardiovascular
patients necessitate active measures to create necessary awareness. Though
misconceptions exist that people with heart disease should not be physically
active, research on patients with coronary artery disease who are non-diabetic
has shown that there is no reduction in exercise capacity. An
exercise intensity of as low as 8-10 minutes has shown improvement in cardiac health among teens.

A recent study by Dr Rune Byrkjeland and colleagues analyzed the effect
of exercise training on carotid intima-media thickness (cIMT) development. This
study, published in the Journal Cardiovascular Diabetology and titled "Effects of exercise training on carotid intima-media thickness in patients
with type 2 diabetes and coronary artery disease. Influence of carotid plaques"
monitored the effect of exercise training on the development of cIMT in
patients with both:

a. Cardiovascular disease

b. Type 2 diabetes

Carotid
Intima Media Thickness (cIMT):

Carotid Intima Media Thickness is a marker for atherosclerosis and other cardiovascular
risk. Research studies by Professor Iana shimova on Carotid Intima Media
Thickness (cIMT) and published in the journal of The European Society of
Cardiology indicate that cIMT measurements should be carried out for
patients at moderate risk for cardiovascular disease.

Table: Patients Requiring cIMT

S. No

Risk

cIMT measurement

1.

Moderate risk of cardiovascular disease- 1-5% of patients.

a. Large proportion of asymptomatic middle aged adults

b. 10 year risk of cardiovascular disease that could prove fatal

cIMT measurement

Carotid artery ultrasound

Atherosclerotic plaques

2.

Hypertensive patients with moderate risk

cIMT measurement

Target organ damage

Carotid artery scanning for:

Asymptomatic atherosclerosis

Vascular hypertrophy

3.

Intermediate risk: 6-20% of patients.

a. 10 years risk of death due to cardiovascular disease or myocardial infarction

b. First degree relative with cardiovascular disease

Carotid ultrasound scanning

4.

First atherosclerotic cardiovascular event

cIMT is not recommended

The importance of cIMT in
cardiovascular disease prevention has prompted numerous research to understand
the mechanisms of disease progression. The new age - research by Dr Rune Byrkjeland and colleagues is a significant
study that analyzed the effect of exercise training on cIMT progression.

The study participants underwent
150 minutes of exercise per week, which extended to 12 months of aerobic(2/3rd)
as well as strength training(1/3rd) which included:

a. Group based with special instructors

b. Home based with individual training

cIMT measurements: cIMT measurements were carried out using high resolution
ultrasonography.

Results of the Study:

No significant change in cIMT
progression among patients with carotid plaques

A significant difference in cIMT
between exercise group and control among patients with no carotid plaques.

Significance
of the Study

Patients with carotid plaques- Patients with advancedstages of cardiovascular disease
with carotid plaques did not show changes in cIMT progression. This does
not mean that exercise training is not beneficial for such patients, only
that the marker for the disease continues to increase. Exercise could
affect other parameters that could contribute to disease progression.

Patients without carotid
plaques- Patients who are at a moderate risk
for cardiovascular disease and who do not have cardiac plaques show
significant control over cIMT progression after exercise training. This is
an indication that early inclusion of regular exercise will control
disease progression.

The health
benefits of regular exercise are essential for everyone, including cardiac
patients with diabetes. Though the benefits may not be as pronounced as when
the disease is at its early stages, the advantages of
being physically active continue to be promising. There are tailor
made work out schedules for cardiac patients that
improve health and fitness without undue stress.

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